Kottow M. Bioterrorismo, biodefensa, bioética. [Bioterrorism, bio-defense, and bioethics.] Cadernos de Saúde Pública [Public Health Notebooks] (Rio de Janeiro, Brazil) 2003 January-February; 19(1):297-303.

Objectives: To analyze the bioethical implications, for public health, of its involvement in the fight against bioterrorism.

Methodology: Analytical and interpretive.

Results: The bioterrorist attacks of 11 September 2001 have raised the level of fear about the possibility of aggressive actions employing biological agents. This development has unleashed discussion and a mobilization of resources aimed at counteracting these threats both for defensive and offensive purposes. Many of these measures, in turn, involve research into and the production of biological agents. The public health establishment has been called upon to participate in these strategic efforts. Participation of healthcare programs is morally inconsistent with military endeavors and should be confined to protecting the health of the presumably threatened population--a difficult task given the diverse imponderables that exist. The additional resources being placed at the disposition of public health are in great measure conditioned upon their use for military-strategic ends, leaving the traditional work of public health to the failures and inequities which chronically afflict it. The incorporation of public health into the fight against terrorism has extremely high costs: it drains medical resources from areas already unprotected; it produces extensive healthcare activities that lack direction; it threatens to introduce prevention measures of questionable effectiveness; it creates unsuspected, possibly discordant risks for citizens quality of life; it directs efforts and resources in collective health off course; and, finally, it risks setting up clashes between political and military interests that in the past have had ominous consequences.

Conclusions: The changing emphasis on bioterrorism in public health has led to a series of difficult challenges that deserve attention from the standpoint of bioethics.